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Acute Abdomen
Defnition An acute intra-abdominal condition o abrupt
onset, usually associated with pain due to
inammation, peroration, obstruction,inarction or rupture o abdominal organs, andusually requiring emergency intervention
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!ive "a#or $ategories o AcuteAbdomen %&'(P')
Bleeding or rupture of vessels or tumor
Ischemia or Infarction
Obstruction
Perforation
Inflammation
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Acute Abdomen
*ypes o Pain Visceral pain
$omes rom the abdominal viscera
*ypically vague and nauseating
!oregut structures % stomach, duodenum, liver, andpancreas ) cause upper abdominal pain
"idgut structures % small bowel, pro+imal colon, andappendi+ ) cause periumbilical pain
indgut structures % distal colon and . tract ) causelower abdominal pain
Somatic pain
$omes rom the parietal peritoneum
/omatic pain is sharp and locali0ed
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Acute Abdomen
*ypes o Pain Ischemic pain1
A very great pain, settled and not receded
Over pain: (ccurs when a segment o the neural serve more
than one area
Projection pain:
Pain caused by sensory nerve stimulation due toin#ury 2 inammation o the nerves
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Acute Abdomen
*ypes o PainHiperestesia1 (ten ound in the s3in i there is inammation
in the cavity underneath Continuous pain:
Pain due to stimulation on the peritoneumparietale will be elt continuously
Colicky pain:visceral pain due to smooth muscle spasms o
hollow organs %peristalsis)Moved pain:
Pain in accordance with the development opathological changes
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Acute Abdomen
tiology
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Acute Abdomen
+aminations eneral 1 !aeces, 5espiratory pulse, &ody temperature,
/ymptoms and signs o dehydration, &leeding, /hoc3,'nection
/pecial test
'liopsoas test
(bturator test
&o+ing percussion test
5ectal toucher1
distinguish intestinal obstruction with intestinal paralysis
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Acute Abdomen
+aminations'nspection
6oo3 or evidence o anaemia2#aundice
6oo3 or visible peristalsis or abdominaldistension
6oo3 or signs o bruising around the umbilicus
or ran3 Assess whether patient is dehydrated %s3in
turgor2dry mucous membranes)
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Acute Abdomen
+aminationsAuscultation
Auscultate abdomen in all our quadrants
Absent bowel sounds suggest paralytic ileus,generalised peritonitis or intestinal obstructionigh-pitched and tin3ling bowel sounds suggestsub-acute intestinal obstruction
'ntestinal obstruction can also present withnormal bowel sounds
' there is reason to suspect aortic aneurysm,listen careully or abdominal and iliac bruits
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Acute Abdomen
+aminationsPercussion
Assess or shiting dullness and uid thrill
Percussion can also be used to determine si0eo an abdominal mass2e+tent o organomegaly
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Acute Abdomen
+aminations &lood cultures
.rinalysis
5adiology
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ACU! APP!"#ICIIS
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Appendicitis
'nammation 7 obstruction o the vermiorm appendi+
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Rowsing Sign: Pain inthe right lower quadrant
when pressure isexerted on the left lowerquadrant
Physical +amination
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Psoas Si$n
%Pain on &e'ion o( the thi$h)
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O*turator Si$n
%Pain on &e'ion and rotation o( thethi$h)
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reatment
/urgical removal
' uids and antibiotics %"etronida0ole,entacimin,$eotetan,$eo+itin)
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+!AM!"PHA+MACO,O-.
Antibioti3
Metronida/ole 0&a$yl1
-entamisin 0-entacidin2 -aramycin1
Ce(otetan 0Ce(otan1 Ce(o'itin 0Me(o'in1
Meropenem 0Merrem1
Piperacillin dan ta/o*actam natrium 03osyn1
Ampicillin dan sul*actam 0Unasyn1 Anal$esik
Mor4n sul(at 0Astramorph2 #uramorph2 MSCO"I"2 MSI+2 Oramorph1
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P!+IO"IIS
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!tiolo$y
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+IS5 6ACO+
Abdominal penetration or trauma 'mmune compromise &lood in the abdomen 5uptured appendi+ Peptic ulcer $olitis Diverticulitis angrene o the bowel Pancreatitis
Pelvic inammatory disease 'named gallbladder 5ecent surgery *ubes or shunts in the abdomen
$ortisone drugs
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o$iPeritoniti
s
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,a*oratory 4ndin$s ande'amination
!luid e+amination or identifcation ogerm
5ontgen 1 supine and PA2AP
/urgery
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Anti*iotic herapy
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'nammatory &owel Disease
/ymptoms Abdominal cramps and pain Diarrhea
!ever 6oss o appetite8eight loss Anemia &leeding % intestines )
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'nammatory &owel Disease
.lcerative $olitis $omplication1
*o+ic megacolon
$olonic peroration
Diagnostic1
sigmoidoscopy 2 colonoscopy mucosalerythema, granularity, riability, e+udate,hemorrhage, ulcers, inammatory polyps
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'nammatory &owel Disease
*reatments Aminosalicylates
*hese drugs can be given either orally or rectally %enema,suppository ormulations) *hey are useul both or treating
are-ups o the '&D and the maintenance o remission
$orticosteroids $orticosteroids are rapid-acting anti-inammatory agents
*he indication or use in '&D is or acute are-ups o thedisease only *here is no role or corticosteroids in the
maintenance o remission
'mmune modifers*hey are useul in reducing or eliminating some personsI
dependence on corticosteroids
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'nammatory &owel Disease
*reatments Anti-*E! agent
'ni+imab %5emicade) is an anti-*E! agent *E! is produced by white blood cells and is believed to be
responsible or promoting the tissue damage noted in personswith $rohnIs disease
'ni+imab acts by binding to *E!, thereby inhibiting its eJectson the tissues
Antibiotics "etronida0ole and ciproo+acin are the most commonly used 'n persons with ulcerative colitis, they have an increased ris3
o developing antibiotic-associated pseudomembranous colitis%a type o inectious diarrhea) 'n persons with $rohnIs disease, antibiotics are used or
the treatment o complications %perianal disease, fstulae,inammatory mass)